Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

Thursday, January 30, 2014

Those of you who have followed the Talk Clean To Me blog
know I am a sucker for alliteration so you can imagine how giddy I am over what
I think is the brilliance of the title for this week's blog!Admittedly, until today I had never heard of
the word Pharaonic - basically a fancy word for big, huge, enormous in size,
but the excitement I had in finding a "P" word was beyond words!

The intent of the Talk Clean To Me blog is to chat about
the use of disinfectants for infection prevention and while they tend to focus
on healthcare, I spend a significant amount of my time working in the Animal Health world (vet offices, shelters, aquaculture, farms, etc) which also has
significant and very real concerns with infections and outbreaks.Being a lover of BBQ (pork shoulder, ribs
etc) and of course bacon, that magical, delectable meat, the news that the
first case in Canada of PEDv (Porcine Epidemic Diarrhea virus) had hit a farm
very close to where I grew up was most concerning indeed.

PEDv is an enveloped virus from a disinfection
perspective that is a member of theCoronaviridaefamily.While PEDv is from the same family of viruses
that was the cause of SARS in 2003 and more recently MERS, it is only
infectious to pigs and is not in any way a food safety concern.Within the swine industry, Coronaviruses are
known to cause to a number of infectious diseases.The significance of PEDvhowever is the mortality rate with an average
of up to 100% in suckling piglets (under the age of 7 days).PEDv is transmitted by direct (pig-to-pig) or
indirect (contaminated fomites, transport truck/trailers, footwear, clothing,
farm supplies, etc) exposed to the virus. The incubation period of PEDv is
thought to be as short as 22 - 36 hrs and is characterized by acute outbreaks
of severe diarrhea and vomiting that can affect up to 100% of the herd if
previously unexposed.The fact that this
is the first time PEDv has been found in Canada means our herds do not have any
immunity to this virus.The economic
impact of PEDv will be substantial.

In the US since the first case was identified in May
2013, more than 2000 farms in 22 states have been grappling with the virus that
has caused the death of at least 1 million baby pigs.The two farms that PEDv has been confirmed
have seen almost a 100% mortality of 2 - 5 day old pigs and 15 - 20% mortality
with older pigs.If the virus was to
spread beyond Ontario, PEDv could cost the Canadian pork industry an estimated
$45 Million in losses.

From a management and decontamination perspective, the
expectation is that most of the commonly used disinfectants used by the swine
industry for their cleaning and disinfection needs will be effective at
inactivating the PEDv virus. There was a recently published study by Iowa State
University that found that a commonly used powder-based disinfectant was not effective against PEDv.The moral to
this study is thorough washing, disinfecting and drying of hog trailers using
traditional cleaning methods and liquid disinfectants is the way to go.For now, the primary concern with respect to
preventing further transmission to other farms is the frigid temperatures we are
experiencing in Ontario - a decrease in temperature impacts the contact time
for disinfectants.They will still kill,
but they will need more time to do so.Just like in healthcare, cleaning and not cutting corners saves
lives.In this case we're talking about
the lives of really cute piglets!

Friday, January 24, 2014

The truth of efficacy testing for disinfectants is that
it's not as easy as just "growing" the bug you want to test and
seeing if a product can kill it.Certainly there is a plethora of scientific literature to show how long
bugs can survive on surfaces and this often leads us to incorrectly conclude,
that if a bug is hardy enough to live on a surface for a significant period of
time then it must be hardy enough to be grown in a lab.

Unfortunately, the organisms of interest cannot always be
reliably cultured ("grown")and as a result surrogate organisms are used.

What the heck are surrogates?Well they are bugs that show genetic and
stability similarities to the bug we're interested in.Perhaps not the best analogy, but one that I
certainly know very well from experience is cooking and baking your favorite
recipes when your husband is allergic to dairy.Milk or cream gets substituted with Soya Milk, Almond Milk or Goat's
Milk.Butter is substituted for
margarine - but beware, depending on the recipe you also need to consider
whether you should use soft or hard margarine and for the record....don't
bother trying to make short bread cookies.With margarine they are NEVER EVER going to taste as good as your
Grandma's.

Getting back to surrogates and Norovirus, at present
there is no recognized cell culture infectivity model for testing efficacy
against Human Norovirus. Efficacy testing relies on the use of viral surrogate
models for which a number of factors are considered in selecting a surrogate
microorganism such as (a) safety for lab workers, (b) ease of culture and
quantitation in the lab, (c) relative resistance to physical and chemical
agents, (d) stability in the ambient environment and (e) a reasonable fast
turn‐around of test results.

Feline Calicivirus (FCV) is currently accepted around the
world as the representative surrogate. FCV is primarily a respiratory pathogen in cats and is found
mainly in respiratory secretions. It is also found in cat feces, which can play a role in FCV spread. FCV is
also known to infect dogs where it can cause

acute diarrhea, thereby making FCV a very suitable
surrogate for Human Norovirus for use in efficacy testing of disinfectants.FCV is the surrogate recognized and approved by the EPA for making claims
against Norovirus on EPA registered disinfectants.

In recent years, we have seen Murine (Mouse) Norovirus
(MNV) suggested as a suitable surrogate as it shows greater genetic similarities, pathological and
environmental stability to Human Norovirus. MNV can be cultured in the lab. While there are greater
genetic similarities between Murine Norovirus and Human Norovirus, Murine Norovirus appears to be less
stable and less resistant to microbicides than FCV.The CDC has
made recommendations in their Norovirus Prevention Guideline to perhaps
consider products that have been tested against both FCV and MNV.That certainly can be done, but the long and
the short is the EPA ONLY recognizes FCV and when it comes to disinfectant
claims in the US - the EPA is the king of the castle!

Certainly, there are a number of researchers who have
presented data showing efficacy of different disinfectants to Human Norovirus.
However, after conducting a quick literature review, I was unable to find any
studies on human Norovirus with an animal end point.There are a number of studies with Human
Norovirus that are based on non-kill parameters (e.g. DNA, RNA, protein
analysis). These types of studies are not accepted by EPA to date as they
do not confirm that the virus has been inactivated. The EPA only accepts
efficacy studies that shows that all cells, eggs, or living animals survive
after the virus has been treated with a disinfectant.

In the end, the debate on which virus is a better
surrogate for the Human Noroviruses is likely to continue for some time to
come. The reality, however, is that the moment you grow a virus in the lab you
alter its surroundings and characteristics, including its susceptibility and
its resistance to physical and chemical agents. I expect science will find a
way some day to effectively grow Human Norovirus so that it can be used to
determine disinfectant efficacy, butfor
now it's a cat and mouse game where FCV reigns supreme (at least in the eyes ofthe EPA).

Friday, January 17, 2014

Unlike the brilliant ESKAPE acronym, I cannot (at least
in the 20 minutes I gave myself) come up with a catchy acronym for
Acinetobacter, Clostridium difficile, MRSA, Norovirus, Pseudomonas and
VRE.ACMNPV is simply the first letter
of each.Perhaps PNAVCM ofVACNMP would be better?

Regardless, according to the December 2013 Primer on Hospital Pathogens published by ICT, these are the pathogens most prevalent in
the hospital environment.These are the
pathogens that should be of significant concern to Infection Preventionists
(IPs).But why?

Acinetobacter baumannii is a lovelygram negative bacterium that can inflict a
wide range of diseases - bacteraemia, wound infections or pneumonia to name a
few.While it poses very little risk to
healthy individuals, those with suppressed immune systems (e.g. patients in
ICUs, Burn Units) or chronic underlying diseases (e.g. diabetes or COPD etc)
present the perfect target for this opportunistic little bugger.From an environmental impact perspective,
Acinetobacter is transmitted via contact (e.g. person to person or indirect via
contact with fomites) and is believed to survive in the environment for several
days and perhaps up to months.

Clostridium difficile is a spore forming gram positive
bacterium.It's the spore forming or
suit of armor creating characteristic that has caused many a grey hair for IPs
around the world.In fact, C. diff
accounts for 15 - 25% of all cases of antibiotic-associated diarrhea.The suit of armor helps increase the length
of survival in the environment making the need for diligent cleaning and
disinfection all the more important and by diligent, I in no way mean that you
try to nuke all surfaces with a sporicidal agent, I mean that we need to do a
thorough job in cleaning and physically removing soils and spores from
environmental surfaces and patient care equipment.But don't just blame the environment or the
housekeeper, antibiotics are the primary cause for development of C.diff
Diarrhea - be sure to look at and question antibiotic prescription practices by
doctors.

Methicillin Resistant Staphylococcus aureus or MRSA to
those in the know, is a gram positive bacterium that is resistant to many
different antibiotics.At any given
time, between 20 and 30 per cent of the general population carry Staph bacteria
and /or MRSA on their hands or in their noses, but are not ill.This is particularly concerning as
researchers have shown that MRSA can survive on environmental surfaces for up
to 56 days!Similar to Acinetobacter,
MRSA can be transmitted via both direct and indirect contact so environmental
hygiene (e.g. cleaning and disinfection) cannot be underestimated in its
importance for keeping MRSA off the surfaces to stop transmission.The good news is that according to U.S.
health officials, MRSA infections have fallen by nearly 30 percent in the last
decade.

Norovirus - a wonderful winter weight loss program - is a
non-enveloped virus that is quite resistant to many of our commonly used
day-to-day disinfectants.It does not
take much of hardy little terrorist to cause infection and can live in
virtually any environment (including at freezing temperatures to 60C/140F).Transmission is primarily caused by eating
poop (the less technical way of stating fecal-oral) and can survive on surfaces
for up to 14 days.While we often panic
over the antibiotic resistant bacteria, we cannot underestimate the economic
burden of Norovirus as it is estimated to cause up to 21 MILLION cases of
gastroenteritis (aka puking and pooping) per year in the US.Best of all you just have to "ride"
it out - viruses are not susceptible to treatment with antibiotics.Focusing on cleaning and disinfection with a
disinfectant that is effective against Norovirus and judicious hand hygiene are
the best means to deal with this bad guy.

Pseudomonas aeruginosa (most commonly referred to as
Pseudo) is a gram negative bacterium that is widely found in the environment
and particularly found on water and moist conditions and accounts for about 10%
of all HAIs.Like MRSA and Acinetobacter
it can be transmitted by both direct and indirect contact and is more concerning
to patient with weakened immune systems.While, Pseudo loves moist environments, it has been found to survive on
dry surfaces for up to 16 months and can cause all sorts of infections
(bacteraemia, pneumonia, UTIs etc) depending on its portal of entry (e.g. how
it got into you).As you've likely
guessed, cleaning and disinfection and hand hygiene will help stop the spread.

Lastly, VRE or Vancomycin Resistant Enterococciare a group of gram positive bacteria that
are naturally present in our intestines, in the female genital tract and the environment.As the name would imply, they are resistant
to some classes of antibiotics and as expected is more concerning with people
who have weakened immune systems.VRE
is a hardy little pest that can survive for extended periods of time in the
environment and can be transmitted by both direct and indirect
transmission.Because of its ability to
survive in the environment, if cleaning and disinfection is not completed with
utmost care researchers have shown there is a VERY strong chance of the next person
admitted into a room or bed previously occupied by someone with VRE.

I would expect the organisms we just reviewed are already
on your hit list for infection prevention programs and intervention
strategies.The key (or theme) I hope
you picked up is the association with transmission from contaminated
surfaces.Cleaning saves lives, but
cleaning is not something that can be rushed because short cuts will cost
lives.

Friday, January 10, 2014

Happy New Year and welcome back to the Talk Clean To Me
blog!While we had a few
"themes" during 2013, our primary focus for topics was covering the
newly published science as it related to the use of chemical disinfectants for
infection prevention.For 2014, Lee and
I have decided to have quarterly themes, certainly we will still intersperse
hot topics as studies that we think are important and worth blogging about hit
the press and we also intend to bring back the Guest Bloggers to bring you
fresh and in some cases hopefully controversial topics and opinions.

The first Quarter will be a focus on relevant pathogens
that cause us grief from an infection prevention standpoint such as Norovirus,
C. difficile, AROs and emerging pathogens we may want to start keeping an eye
on.By no means do I mean we will start
creating dull FAQ type blogs on these pathogens.Just the thought of that makes me yawn.Besides we can find much of that information
on the CDC, Health Canada or WHO websites.Our focus will be much more exciting such as how to choose a
disinfectant when specific pathogen claims do not exist or why surrogates are
used for some claims rather than the actual pathogen.OK, perhaps that doesn't seem much better,
but I promise you'll we'll make the blogs fun to read and perhaps even get a
snort out of one or two of you!

The second Quarter (or Q2 as most business people would
shorten it to) will look at the costs and return on investment in designing and
implementing an environmental infection prevention and control program.If Lee and I do our jobs correctly, we'll
arm you with a laundry list of what we call "So What's" that should
counter virtually any road block thrown in your path to improving your
environmental infection prevention and control program.

Q3 (yep, that's the third quarter) will focus on
Occupational Health and Safety, covering topics such as OSHA's Hazard
Communication standards, the new Global Harmonized Systems, changes to Safety
Data Sheets (formerly known as MSDS) and how as people tasked with choosing
disinfectants consideration to more than just the cost of a product and what it
kills needs to be considered....we want to kills germs, not our staff, even if
some of them "bug" us!

To finish off the year, we'll spend some time looking at
how we can "green" our environmental cleaning programs not just in
terms of choosing chemicals, but looking at processes and how small changes to
how we clean and disinfect can improve our bottom lines.

We enjoy your comments and would love to hear from you as
to topics that would be of interest!